Therapy in bloom.

More than aromatic flowers, it's where self-esteem blossoms

BETHANY TERRACE NURSING CENTRE is an example of how some of the best ways to treat residents evolve organically. Sure, there is something to be said for incorporating resident activities like an applique to the overall fabric of a facility and the amenities it offers. It is altogether different when the amenities that a facility offers are the outgrowth of the needs and desires of its residents--a reflection of those who live there. Such is the case with the therapy and meditation gardens cultivated by residents at Bethany Terrace.

"I have so many residents who had a leisure history of gardening," says Bethany Terrace Director of Activities Lori Lentz. "We had no program for them. But people who wouldn't go to exercise class would come out and pull weeds for us. It's a wonderful range-of-motion exercise for them. So many residents want to do this," she explains.

Bethany Terrace, located in Morton Grove, Ill., is typically host to 260 residents in its 275-bed facility. The facility features a therapy garden inspired by the Chicago Botanical Gardens, as well as a separate meditation garden. The concept of offering such garden spots started in 1992, with the first one being completed in 1993.

"When I started working here 20 years ago many of the residents wanted to garden. They were all in wheelchairs. So we got whiskey barrels to raise tiny gardens for them to work on," Lentz says. But such a rudimentary "garden" would not suffice for long.

How to plant a garden

"The garden as we now know it came to be when the husband of one of our Alzheimer's residents--a man who had always gardened--wanted a place for himself and his wife to sit in when he came to visit. It was originally just a concrete patio with shrubs. He said he'd like to get together with our then-CEO. Bethany Foundation, along with this gentleman's help, raised the money to create a Japanese garden," Lentz explains.

She estimates that since its inception, more than 200 residents have worked in the garden. "We might have as many as 20 at any one time," she says.

When ready to make the concept of a therapy garden a reality, Bethany Terrace started by taking bids from local landscape architects. The facility chose Mileau Design in Northbrook, Ill. "We all met with horticultural therapists and, along with the Chicago Botanical Gardens, created the designs," Lentz says. "If a nursing facility is looking for a garden, it should use its local botanical garden as a resource," she offers.

Mileau incorporated a lot of curves and a lot of areas in the garden, such as a sensory area, which has vegetation that sways in the breeze and a waterfall for residents to hear. The meditation garden is made up of plants selected for their fragrances as well as their ability to attract butterflies. It's away from the main garden, which is primarily a planting garden.

The Botanical Garden has a program that Bethany Terrace applied for, wherein international field agents do their internship at the facility. They come and teach the staff at Bethany Terrace about horticulture therapy. In addition, the facility has a materials contract with the Botanical Garden for indoor gardening during the winter as well as outdoor gardening during the summer.

What should your garden grow?

"We have dye to create different colored carnations for celebrations like St. Patrick's Day," says Lentz. "We make pumpkin monsters for Halloween," she continues. "We can't carve because that's risky with the elderly, so we take natural vegetation like zucchini and cauliflower and attach them to the pumpkins with toothpicks to create faces. These pumpkins are then displayed in the common area; children from the local schools come for a parade of costumes! We then give the children the pumpkins to take home.

"We make potpourri from the dried flowers, so they reap the benefits from that, too," says Lentz. "The benefits reach to our cooking class as well. We cook with the vegetables that are grown and picked here."

Winter projects. "We did one project called water wicking of African Violets," says Lentz. "You can't get their leaves wet when you water them, otherwise the leaves will turn brown and die. You have to stick a candlewick in the bottom of the pot, where the water drains, and then water the plant by putting the pot in a saucer of water; the candlewick draws the water to the roots of the plant."

Summer projects. "In the summer we clean the garden and do a lot of weeding. The residents do as much as they can. Some sit in their wheelchairs and churn the soil with trowels. We have adaptable tools that are lightweight and that have oversized handles. Watering wands are attached to a hose at wheelchair height. The on/off nozzle is a simple lever. There's no turning of knobs. We have little hand rakes that the residents work with," she explains.

The therapy garden includes two apple trees, zucchini and strawberry plants, and an area dedicated to scented geraniums and other olfactory plants. There are also chocolate-- and cinnamon-scented geraniums. "We'll snip off and rub a leaf on the resident and ask them what that smells like; it always gets a big smile from them," Lentz says.

There are two fountains in the garden, surrounded by rocks and plants, suggesting a pond. A spray of water comes up in the middle of this pond. The noise and visual are said to have a calming effect.

Make it accessible

The garden had to be user friendly. "We have pulleys with hanging plants. The resident can lower each plant to water and prune it," says Lentz.

There's a vertical garden on wheels. This is a huge wooden container with latticework on both sides and wheels on the bottom. Lentz lined it with landscape fabric and poured soil in it. "In the spring we cut slits and plant horizontally instead of vertically. So by the summer we have annuals that are growing like a flowering wall. There is PVC pipe with holes in it that runs from top to bottom to facilitate watering these," she explains.

Everybody enjoys the garden, Lentz says. In fact, financial support for its upkeep often comes from family members who make a memorial donation on behalf of a loved one who has passed. "We have a cast-iron plaque that offers a memorial remembrance in honor of residents passed," she says.

How much does nature cost?

The initial cost to create the benches, ponds, and to relocate an 80-year-old pine tree, cost Bethany Terrace $50,000. "We had to put water spigots and workstations in place," Lentz says. "The most money was for the concrete. The concrete pathways had to replace old concrete walkways. The garden alone--soil and flowers--costs about $1,500 a year to maintain. The year-round program, which requires materials such as soil, plants, and projects for the indoor garden, is an additional $3,000."

Now that it is done, what would she do differently? "In hindsight I'd put in an in-ground water system. It takes a long time to have them water the flowers that are in the ground," Lentz says. "I also wouldn't make it as big as it is; it's huge! It's very labor-intensive for the staff as well as for the residents. I would use more perennials than annuals. Also, we don't have many trees. It's very sunny and a lot of residents need more shade, so I would put more shade trees in," she shares.

Getting residents interested

The facility is proud of its gardens and makes their presence known to residents upon arrival. "The activity department does a comprehensive assessment within the first seven days of a new resident's arrival. We ask them about their previous leisure history. If they tell us they used to garden, we take them out immediately and show them our garden. After some residents see other residents with their completed projects, they'll come ask us about it," says Lentz.

Lentz says that after seeing the residents working in the garden, their first comment is usually, "I can't do this." To those residents Lentz says, "Then come and watch." Then she gets sneaky. "Once they're involved in watching the residents and me work in the garden, I'll trip my beeper. Well, to answer my page, I'm 'forced' into having to hand them a watering wand or a rake. When I return, there they are, working the garden!" says Lentz "They just need the encouragement. They need to know that you need their help."

Garden work nourishes the spirit

"I always thought that one of the plagues of being in a nursing home was that residents don't think that they're of use anymore. They think they're of no use to anyone," says Lentz. "They need to know that they can nourish and grow things and take care of living things. It gives them such joy to know they can care for the garden. That's one of the biggest benefits I see. The exercise and range of motion they get is one benefit. The feeling of being needed is another. We help them recognize their abilities."

She continues, "It's a real stress reducer, especially for our early-stage Alzheimer's residents who participate in the gardening. It gives them the chance to walk and get sun on their face. It gives them a purpose. And they're working hard because most of them can walk and shovel and pull weeds," she says.

Gardening is especially helpful for residents suffering from sundowning, where some of them would get anxious later in the day. "The gardening seems to exhaust them and reduce their pacing. The exercise and fresh air just relax them. They sleep better, I think," says Lentz.

Now Lentz gets gardening magazines at home. "I learned how we can put a little laminated post next to every flower and vegetable in the garden indicating which resident planted which plant and what the plant is. This does wonders for the residents' self-esteem," she says.

The family that hoes together, grows together

"We have an intergenerational program, a 'baby brigade,' where the residents and children plant a small section of the garden," Lentz points out. "The residents and kids working together make for a fun activity. The grandchildren like it as much as the grandparents do."

Lentz and Bethany Terrace prove that the greatest crop their garden yields is resident self-esteem.